Healthcare Provider Details

I. General information

NPI: 1043974033
Provider Name (Legal Business Name): G A CARMICHAEL FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W FRANKLIN ST
CARTHAGE MS
39051-3703
US

IV. Provider business mailing address

1668 W PEACE ST
CANTON MS
39046-5332
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-5213
  • Fax: 601-859-8771
Mailing address:
  • Phone: 601-859-5213
  • Fax: 601-859-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH DAVIS
Title or Position: CHIEF OPERATION OFFICER
Credential: MHA
Phone: 601-859-5213